A 30-year-old farmer presents with a well-defined, hypopigmented patch on his trunk with broken hair follicles and fine scaling. Wood's lamp examination reveals bright yellow-green fluorescence. KOH mount shows short curved hyphae and clusters of round spores resembling 'spaghetti and meatballs.' What is the diagnosis and the recommended systemic treatment?
- A Tinea versicolor; oral itraconazole 200 mg once daily for 7 days ✓
- B Tinea corporis; oral griseofulvin 500 mg daily for 4 weeks
- C Pityriasis alba; no antifungal required, emollients only
- D Tinea versicolor; topical selenium sulfide only, no systemic needed
Explanation
The 'spaghetti and meatballs' appearance on KOH mount (short curved hyphae with clusters of spherical spores) along with bright yellow-green Wood's lamp fluorescence is diagnostic of Pityriasis (tinea) versicolor caused by Malassezia furfur. While topical agents (selenium sulfide, ketoconazole shampoo, azole creams) suffice for limited disease, recurrent or widespread disease warrants systemic therapy. Oral itraconazole 200 mg daily for 5–7 days is effective and currently preferred; oral fluconazole 300 mg single dose or weekly for 2 doses is an alternative. Griseofulvin has no activity against Malassezia.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.